Orbital tumors

 

Any tumor located in the orbit is called orbital tumor. Orbit is the bony socket in the front side of the skull that contains the eye. Besides eyes, the socket also contains muscles, nerves and connective tissues. The socket is wide in the front and gets narrower towards the back, where the optic nerve leaves the socket and connects to the brain. If you get a large tumor in the socket, it causes the eye to bulge forward and can cause serious vision problems. Small or tiny tumors cause functional defects.

Orbital tumors can be benign or malignant. Some orbital tumors occur most commonly in children, others are more often found in adults. Most of the childhood tumors are caused due to developmental abnormalities.

The most common benign tumor of the orbit is the cavernous hemangioma, which mostly develops in young or middle-aged adults. These tumors can be removed surgically and rarely recur once they are removed. Most orbital tumors in children are benign, but need to be treated to preserve vision. Malignant tumors are unusual in children. Any rapidly growing mass should be something to be considered seriously by parents. Most adults with orbital tumours are in their 60s and 70s.

People can have benign tumours or inflammatory diseases of the orbit, as well as malignant tumours. Primary malignant tumours of the orbit are uncommon.

The most common malignant orbital tumours in adults include lymphoma, sarcoma, optic nerve glioma. Malignant orbital tumours can also include cancers that have spread to the orbit from eyeball, eyelid, conjunctiva, sinuses or nasal cavity. Metastic tumors mostly arise from the breast and prostate, while squamous and basal cell cancer can develop in the orbit from surrounding skin and sinus cavities.

Cancers from other parts of the body, such as the breast, lung, prostate, brain and kidney, can also spread to the orbit. Melanoma skin cancer can also spread to the orbit, but this is not common.

Rhabdomyosarcoma is the most common orbital tumour in children that occurs between the age of 7 and 8. This tumor grows at a fast pace and can be life-threatening if it grows into the brain or spreads into lungs.

What causes an orbital tumor?

Some orbital tumors develop when a cancer in another part of the body spreads to the orbit. Other orbital tumors are primary, developing in the socket of orbit for unknown reasons.

Thyroid opthalmopathy

Many orbital tumours present with proptosis or bulging of the eyeball. This is one of the most common causes of thyroid related immune orbitopathy.

Thyroid ophthalmopathy is mostly four to five times more common in women, particularly when they are in their perimenopausal phase. History of cigarette is also related to this tumor. Pathogenesis of the disease is unclear. Anterior segment eye complaints are treated with lubricants and topical steroids. Glaucoma is managed with topical anti-glaucoma medications. Diplopia might need steroids and surgery while proptosis might require steroids, radiation or corrective surgery.

Graves disease

Graves’ disease and Graves’ disease of the orbit are autoimmune diseases. These affect the eyelids, eye socket or orbit, and most of the soft tissues around the eye. They act like tumor invading the fat and muscles in the orbit. Both types of Graves’ disease may show eyelid retraction with a resulting thyroid stare and some degree of exophthalmos (excessive prominence of the eyes). Both these diseases can cause severe esthetic problems as well as serious medical problems. If left untreated, they can lead to a loss of vision and even blindness.

Symptoms of an orbital tumor

Symptoms of an orbital tumor may include:

  • Bulging of the eyeball
  • Flattened eyeball
  • Numbness or tingling around the eye
  • An inability to move one eye
  • Vision changes or loss
  • Pain around the eye
  • Swollen or droopy eyelid

Some tumors are easily visible and so are quickly identified. Others may not be exhibit any symptoms until they are large and displace the eyeball. In children, parents may first notice droopy eyelids or protrusion of the eye.

These symptoms does not necessarily indicate orbital tumor, they can be due to many reasons. Patients experiencing them should be examined by an eye doctor. The service of a specialist should be immediately sought if the tumor is confirmed. The patient will be sent for an MRI or CT scan to determine the size and location of the tumor. These scans are necessary to make an exact diagnosis.

Treatment of orbital tumors depends on their size, location and type. Some tumors may not need any treatment at all, while some may need medical intervention or use of radiation therapy. After removal, the patient may be given additional radiation or chemotherapy.

In some cases, a surgical biopsy may be necessary. An accurate diagnosis is critical to the development of treatment.